Once you have decided to introduce formula and begin mixed feeding, what is the best way to go about it? If you have been fully breastfeeding, embarking on a new routine of mixed feeding with formula means you will need to reduce the amount of milk that you are making, as your baby will get some of his milk through a different route. The breastfeeding system of supply and demand will do this automatically in response to your baby suckling less at the breast. How to start?
If you want to introduce formula while continuing to breastfeed, it is best to wait until breastfeeding is well established (usually 4-6 weeks) so formula has less on an effect on your breastfeeding. The general rule is that the younger the baby when combined feeding begins the harder it can be to maintain supply. Waiting also reduces the chance that your baby will end up preferring the faster, easier flow of the bottle.
When replacing breastfeeds with formula feeds, your body will benefit from a gradual rather than a sudden reduction. It is best to drop only one feed at a time. It takes approximately 3-7 days for your breasts to adjust to missing one feed, so try dropping one feed per week. Your body will then have received and acted upon the message to produce less milk before you drop another feed. In this way, you should avoid becoming painfully engorged. Gradually dropping feeds also gives your milk supply time to adjust to the lower demand, rather than sudden changes which can cause your supply to go into freefall. Ideally, you could even continue pumping at the normal feed time, but gradually pump less and less. When dropping a feed, try to keep other feeds at their existing times to help your supply adjust accordingly.
There is no *best* feed to replace with formula. In some cases, such as a return to work, the decision is made for you for scheduling reasons. Many moms choose to do formula for a dream feed to allow their partner to be more involved with feeding while they get some much needed rest!
Other moms choose to do formula for an evening feed, as that is naturally when our milk supplies tend to be the lowest. There are no right or wrong feeds to replace, so you can choose what works best for you and your family.Points to consider
First, because breastmilk is produced on a supply-and-demand basis, the more formula you give your baby, the less milk you'll produce. Some moms are able to do mixed feeding successfully, while others may have problems with their breastmilk supply. It is always hard to predict what will happen to your milk supply when you introduce formula as every mom is different. Clues that you may be having supply problems include extra nightwakings caused by hunger, difficulty achieving a letdown when you are breastfeeding, and baby being frustrated at the breast. If you fear that you may be having supply problems due to the transition to mixed feeding, see "I'm worried I may have a low milk supply"
for information and help.
Another possibility, especially when starting mixed feeding with younger babies, is that baby will begin to prefer the bottle to the breast, which can lead to early and unintentional weaning. Tracy said that nipple confusion is a myth but that there can be a problem with 'flow' confusion. One way to help prevent this is waiting until breastfeeding is established before introducing mixed feeding. Another thought is to change to a bottle where sucking is needed to be more in a breastfeeding style. Fast-flow and even slow-flow nipples allow milk to just flow into babies' mouths regardless of sucking. Variable flow nipples (also known as variflow or y-cut) force the baby to suck to get milk. Then the difference between bottle and breast may not be so pronounced. (If you begin to notice a bottle preference and you want to continue breastfeeding, try to breastfeed as much as possible and offer formula as a supplement after breastfeeding - you can offer the formula by cup, syringe, etc. to help overcome the bottle preference - and post on the breastfeeding board for assistance.)
Also, no formula can exactly duplicate the ideal composition of breastmilk. If your baby starts to show symptoms such as irritability, crying after feedings, nausea, vomiting, diarrhea, hives, or a skin rash after the introduction of formula talk to your doctor. Formula-fed babies run the risk of developing an allergy or intolerance to a particular formula. Some babies who tolerate breastmilk with no ill effects (regardless of momís diet) are found to have MPI/MSPI/allergies when formula is introduced.
Finally, it's important to note that not all ebf babies will accept mixed feeding. Breastmilk is quite sweet, and (at best!) formula is very chalky - at worst, if your baby has allergies or intolerences, hypoallergenic formulas really do taste foul. Even if your baby accepts a bottle of ebm with no problems, the taste of formula can really put them off. Sometimes, mixing it with ebm and gradually increasing the amount of formula in the mix will ease the transition and make mixed feeding possible. For an example of this type of gradual transition, see the bottom of From breast to bottle: a gradual weaning method
for details.The final word
Mixed feeding can work very well but it's important to remember that itís not a magic bullet. Your baby will not suddenly start sleeping through the night, it won't cure reflux or colic, or change a touchy or grumpy baby to a textbook or angel bub. But if exclusive breastfeeding is not working for you, it's important to remember that a happy and healthy baby needs to have a happy and healthy mom! Mixed feeding is a solution that allows your baby to receive the amazing benefits of breastmilk while giving you the flexibility and help that you need. Remember that you should be proud of your continued efforts to breastfeed, and that every drop of breastmilk your baby receives is a gift!